93 Decision Citation: BVA 93-21456
Y93
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 92-15 599 ) DATE
)
)
)
THE ISSUES
1. Entitlement to service connection for renal glycosuria.
2. Entitlement to a compensable evaluation for hemorrhoids.
REPRESENTATION
Appellant represented by: The American Legion
ATTORNEY FOR THE BOARD
S. D. Regan, Associate Counsel
INTRODUCTION
This matter came before the Board of Veterans' Appeals (hereinafter
"the Board") on appeal from a May 1991 rating decision of the
Houston, Texas regional office (hereinafter "the RO") which, in
pertinent part, denied service connection for glycosuria and granted
service connection for hemorrhoids and assigned a noncompensable
evaluation. The veteran had active service from August 1960 to July
1990. The notice of disagreement was received in June 1991. The
statement of the case was issued in July 1991. The substantive
appeal was received in August 1991. A supplemental statement of the
case was issued in October 1991. A second supplemental statement of
the case was issued in May 1992. The veteran has been represented
throughout this appeal by the American Legion. That organization
submitted written argument in July 1992. The appeal was received at
the Board in August 1992 and docketed in September 1992. A written
presentation from the accredited representative was submitted in
October 1992.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran asserts on appeal that the RO erred in denying service
connection for glycosuria and in failing to grant a compensable
evaluation for his hemorrhoids. The veteran contends that service
connection should be granted for glycosuria as he tested positive for
the condition several times during service. He contends that his
treatment records and current symptomatology indicate that a
compensable evaluation is warranted for his hemorrhoids.
DECISION OF THE BOARD
The Board, in accordance with the provisions of 38 U.S.C.A. § 7104
(West 1991), has reviewed and considered all of the evidence and
material of record in the veteran's claims file(s). The Board has
determined that only those items listed in the "Certified List"
attached to this decision and incorporated by reference herein are
relevant evidence in the consideration of the veteran's claim. Based
on its review of the relevant evidence in this matter, and for the
following reasons and bases, it is the decision of the Board that a
preponderance of the evidence is adverse to the veteran's claim for
service connection for renal glycosuria and for a compensable
evaluation for hemorrhoids.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable disposition of
the veteran's appeal has been obtained by the RO.
2. The veteran was shown to have renal glycosuria on several
occasions during service.
3. Renal glycosuria is a congenital or developmental disorder.
4. The veteran manifests no more than mild to moderate internal
hemorrhoids.
CONCLUSIONS OF LAW
1. Renal glycosuria was not incurred in or aggravated by active
service. 38 U.S.C.A. §§ 1110, 1131, 5107, 7104 (West 1991); 38
C.F.R. § 3.303(c) (1992).
2. The schedular criteria for a compensable evaluation for
hemorrhoids have not been met. 38 U.S.C.A. §§ 1155, 5107 (West
1991); 38 C.F.R. Part 4, including § 4.3, 4.7, and Code 7336 (1992).
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
The veteran has submitted well grounded claims within the meaning of
38 U.S.C.A. § 5107(a) (West 1991). That is, we find that he has
presented claims which are plausible. We are also satisfied that all
relevant facts have been properly developed and no further assistance
is required to comply with the duty to assist him as mandated by 38
U.S.C.A. § 5107(a) (West 1991).
I. Glycosuria
Service connection may be granted for a disability arising from
disease or injury incurred in or aggravated by active service. 38
U.S.C.A. § § 1110, 1131 (West 1991). Congenital or developmental
defects, as such, are not diseases within the meaning of the
applicable legislation providing for Department of Veterans Affairs
(hereinafter "VA") benefits. 38 C.F.R. § 3.303(c).
A review of the veteran's service medical records reveals that renal
glycosuria was first indicated in 1976. A November 1976 annual
flying examination revealed that the veteran had renal glycosuria. A
December 1976 statement as to the veteran's waiver for flying
reported that the veteran had a glucose tolerance test that
demonstrated asymptomatic hypoglycemia. The statement indicated that
the condition had not caused the veteran to present himself to a
flight surgeon and that it was unlikely that he experienced such a
degree of rise and fall of blood sugar following a regular diet as to
constitute a hazard to flying safety. A December 1976 treatment
record noted the veteran had no signs or symptoms of diabetes per
history. In June 1983, a treatment record entry noted that the
veteran's 2 hour post prandial urine measured 2+. A November 1983
internal medicine consultation reported the veteran denied such
symptoms as polyuria, polydipsia, fatigue, malaise, blurred vision or
peripheral neuropathy. The examiner recommended a dietary
consultation and indicated that normal FBS and 2 hour PPBS could then
be achieved. A March 1984 treatment record entry noted a
recommendation of a dietary consultation to achieve the ideal body
weight on the "ADA DM diet."
A March 1987, flight surgeon's aeromedical summary indicated that in
November 1976 the veteran underwent a three hour glucose tolerance
test which indicated his serum glucose levels were normal, but his
urine showed trace glycosuria at one and two hours. The report
indicated that several repeated glucose tolerance tests in subsequent
years were performed and that except for one test all the other tests
failed to reproduce a finding of glycosuria. The relevant diagnosis
was history of renal glycosuria. A history of renal glycosuria was
indicated on the veteran's annual examination reports post 1976.
The May 1990 retirement examination revealed that the noted sugar in
urine referred to two episodes of renal glycosuria in 1976 and that
the veteran was seen by a specialist and it was considered resolved.
On the discharge examination a fasting blood sugar was normal and
urine was negative for sugar. The veteran underwent a VA examination
in December 1990. On a surgical examination, the examiner indicated
that the veteran had several episodes of glycosuria by history with
workup for diabetes which should be investigated by internal
medicine. Blood and urine studies revealed a normal blood glucose, a
normal glucose tolerance test, and no glucose on urinalysis. In the
diagnosis, the examiner noted no glycosuria was found. Diabetes
mellitus was not diagnosed.
On a January 1992 VA examination a blood sugar was normal and the
urine sugar was negative. The assessment was glucosuria,
intermittent, not currently present.
The Board observes that glycosuria is defined as "the presence of
glucose in the urine, especially the excretion of an abnormally large
amount of sugar in the urine, i.e., more than 1 gm in 24
hours...Renal glycosuria is defined as glycosuria occurring when
there is only the normal amount of sugar in the blood, due to
inherited inability of the renal tubules to reabsorb glucose
completely". Dorland's Illustrated Medical Dictionary 708 (27th ed.
1988). The Board notes that the claimed disorder is considered to be
an inherited inability to reabsorb glucose. The Board further notes
that the veteran has not been diagnosed with diabetes and that the
most recent VA examination indicated that the veteran's glycosuria
was intermittent and not currently present. Under the facts of this
case, the Board finds that the veteran's renal glycosuria is a
congenital defect and, therefore, not a disease within the meaning of
applicable legislation providing for VA benefits. 38 C.F.R.
§ 3.303(c) (1992). Accordingly, service connection for renal
glycosuria is denied.
II. Hemorrhoids
The veteran's service medical records indicate hemorrhoids were noted
during his period of service. A March 1989, narrative summary of the
veteran's hospitalization for heart surgery noted the veteran had
actively bleeding hemorrhoids. An August 1989 treatment consultation
record reported the veteran had two episodes of rectal bleeding
probably associated with hemorrhoids.
The veteran underwent a VA surgical examination in December 1990.
The examiner reported that the veteran had minimal left anterolateral
and right posterolateral grade I internal hemorrhoids without
evidence of bleeding or inflammation "at this stage".
Disability evaluations are determined by comparing the veteran's
present symptomatology with the criteria set forth in The Schedule
for Rating Disabilities. 38 U.S.C.A § 1155 (West 1991); 38 C.F.R.
Part 4 (1992). A noncompensable evaluation is warranted for mild or
moderate external or internal hemorrhoids. A 10 percent evaluation
requires large or thrombotic, irreducible hemorrhoids with excessive
redundant tissue evidencing frequent recurrences. A 20 percent
evaluation requires persistent bleeding with secondary anemia or
fissures. 38 C.F.R. Part 4, Code 7336 (1992). Where there is a
question as to which of two evaluations shall be applied, the higher
evaluation will be assigned if the disability picture more nearly
approximates the criteria required for that rating. Otherwise, the
lower rating will be assigned. 38 C.F.R. § 4.7 (1992).
A July 1991 treatment record indicated that the veteran requested to
refill his medication for hemorrhoids. The veteran has stated on
appeal that he has had occasional bleeding and inflammation of his
hemorrhoids.
A January 1992 VA surgical examination reported, as to history, that
the veteran developed hemorrhoids with rectal pain and bleeding in
1975. The veteran was told he had hemorrhoids at the time and was
treated with ointment. He was examined and treated for hemorrhoids
again in 1979. The veteran was told he had increased internal and
external hemorrhoids and was treated with ointment. The examination
report further indicated that the veteran had flexible sigmoidoscope
examinations in 1989 and 1990 to rule out problems associated with
rectal bleeding or problems that would cause rectal pain or bleeding.
The tests were negative. The examination report also indicated that
the veteran's symptoms of hemorrhoids with rectal bleeding had
improved slightly over time. Upon examination, the examiner reported
that examination of the rectum revealed internal hemorrhoids with
normal sphincter tone and a negative occult blood study. The
relevant diagnosis was internal hemorrhoids present, relatively
asymptomatic at this time.
The Board has made a careful longitudinal review of the record. We
note that there is evidence of bleeding hemorrhoids during service.
However, disability evaluations are determined based on present
symptomatology. 38 U.S.C.A § 1155 (West 1991); 38 C.F.R. Part 4,
(1992). We observe that the most recent VA examination indicated
relatively asymptomatic internal hemorrhoids, with no evidence of
bleeding as shown by a negative occult blood study. The evidence
does not indicate that the veteran presently suffers from persistent
bleeding hemorrhoids with secondary anemia or fissures or that he has
large or thrombotic frequently recurring hemorrhoids with excessive
redundant tissue. 38 C.F.R. Part 4, Code 7336 (1992). The evidence
suggests no more than mild to moderate internal hemorrhoids.
Therefore, the Board finds that a compensable evaluation is
unwarranted.
We have considered the potential application of various provisions of
Title 38 of the Code of Federal Regulations (1991), whether or not
they were raised by the veteran, as required by the holding of the
United States Court of Veterans Appeals in Schafrath v. Derwinski, 1
Vet.App. 589, 593 (1991). In particular, we find that the evidence
does not suggest that the veteran's hemorrhoid disorder presents such
an exceptional or unusual disability picture as to render impractical
the application of the regular schedular standards so as to warrant
the assignment of an extrashedular evaluation under the provisions of
38 C.F.R. § 3.321(b)(1) (1992).
ORDER
Service connection for renal glycosuria is denied. A compensable
evaluation for hemorrhoids is denied.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
JEFF MARTIN IRVIN H. PEISER, M.D.
*
*38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of Veterans'
Appeals Section, upon direction of the Chairman of the Board, to
proceed with the transaction of business without awaiting assignment
of an additional member to the Section when the Section is composed
of fewer than three Members due to absence of a Member, vacancy on
the Board or inability of the Member assigned to the Section to serve
on the panel. The Chairman has directed that the Section proceed
with the transaction of business, including the issuance of
decisions, without awaiting the assignment of a third Member.
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a
decision of the Board of Veterans' Appeals granting less than the
complete benefit, or benefits, sought on appeal is appealable to the
United States Court of Veterans Appeals within 120 days from the date
of mailing of notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board was filed
with the agency of original jurisdiction on or after November 18,
1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402
(1988). The date which appears on the face of this decision
constitutes the date of mailing and the copy of this decision which
you have received is your notice of the action taken on your appeal
by the Board of Veterans' Appeals.